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Prostate volume and total prostate specific antigen in a population-based early detection programme
189 A VISUAL
ANALOGUE SCALE TO EVALUATE THE SEVERITY OF BENIGN PROSTATIC HYPERPLASIA - A PILOT STUDY IN TWO UROLOGICAL CENTRES
reillac P.‘. Terrier N.‘, Rozct F.‘. Monglat-hrtus Kambcaud J.’
P.‘. Montauban V.I. Musrynski
R ‘.
190 AND TOTAL PROSTATE IN A POPULATION-BASED EARLY DETECTION
PROSTATE
VOLUME
Seberi G.‘. Horningcr G.‘. Bovle P.’
W.
, Bergor
A.
. Obrraigncr
SPECIFIC ANTIGEN PROGRAMME
W.‘, Robertson
C.‘. Bartach
‘HKpital Saint-Louis. Urology. Paris. brance. ‘Hdpital Albert Michalon, Chirurgie Urologique. Grenoble, France. ‘Yamanouchi Pharma France. Medical Affairs, Parir. France
‘European institute of Oncology. Milan. Italy, ‘University of Innsbruck, Urology, Innsbruck, t\ustria, ‘University of Innsbruck, Tyrol Cancer Registry. Innsbruck, -\ustria
INTRODUCTION & OBJECTIVES: Half of men older than SO years who have benign prostatic hyperplasia (BPH) arc not diagnosed. In addition. there are difficulties in using the International Prostate Symptom Score (I-P%) questionnaire m general practice. The aim of this pilot study was to investigate the correlation between the I-PSS questionnaire and a visual analogue scale (VAS) proposed as a ne\+ evaluation tool in BPH
INTRODUCTION & OBJECTIVES: Roehrbom ct al. (Urology 53:581SX9.1999) have demonstrated a positive correlation bctwccn total PSA and prostate volume in patients with clinical BPH. This association was mvrstigatcd among participants in a population-based early prostate cancer detection
MATERIAL & METHODS: 65 patlents (66*9 years, I-PSS: 13.6i7.0)
programme. Given the high participation rate. this is a more represenlativc sample of men from a general population. In addition, we examined associations with other factors including biopsy outcome, free PSA and transilion xmc 1 olume.
RESULTS: The values of the VAS wcrc independent of the age of the patient. The
MATERIAL & METHODS: A total of3.797 screening \oIuntccrs in the Tqrol PSA Screening Project. who underwent prostate biopsies were evaluated. Linear models were applied to srudy the association ofvarlous factors to (the logarithm of) prostate volume
from two urological centres in France were asked the question “how much of a problem do you have urinating?” They answered using a VAS of various lengths: scvcr~ patients noted a score on the VAS of IO and 35 cm Icngth. 30 patients rcphed on the I5 cm V.4S and 28 replied on the 20 cm VAS. In addition, they all completed the I-PSS.
four grades of seventy of the I-PSS were also represented for the VAS group\ (p-0.999). The 20 cm VAS showed the strongest correlation with the I-PSS (R=O.91. ~:O.OOOl). The correlation coefficients wcrc 0.26. 0.67 and 0.72 for the VAS of IO. 15and 35 cm. respectively. The figure below shows the relationship between the 20 cm VAS and the grades of scverltyin the I-PSS.
_ :*
T
T _
I
’ -
RESULTS: Median age. prostate volume and transition Lone volume are 64. 34cc and I3 cc respectively. A linear and positive correlation was found between prostate volume with total serum PSA and age; furthermore we found that the association between PSA and prostate volume increases signif,cantly with age (p iO.001). Also free PSA was positively associated with prostate volume (p iO.001). The increase in prostate volume with increasing age was not intluenced by biopsy findings. For transition Lone volume a positive association for age, total PSA and fret PSA was found. CONCLUSIONS:
CONCLLISIONS: This pdot study hhowcd a correlauon bctv,ccn the I-PSS results and the 20 cm VAS. This VAS could therefore bc used as a simple tool in the accuraIc assessment of BPH by general practitioners. A large-scale study IS necessary to calldate Its USCby general practitioners
As shobn previously in BPH patients. there is a positive between prostate volume and total serum PSA m the general male population. I’he association hctween total PSA and proatatc volume increases with age in a statistically sigmticant manner. Biopsy outcome (canccr/NbD) did not intluence the lncrcase 111prostate volume with increasing age.
191
192
IPEE
CORRELATIONS BETWEEN COMPLEXED, FREE AND TOTAL PSA LEVELS WITH PROSTATIC VOLUME AND HISTOLOGIC INFLAMMATION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA Scattoni V.‘. Montorsi F.‘. Rabcr M.‘. Naapro R. :M.‘, Potenloni M.‘. Rigatti P.’ ‘II San Raffaele, Urology.
Milan.
Paal A
Salonla A
Italy, ‘H San Raffaele. Pathology. Milan,
.
RESULTS: IO5 patients presented media&-PSA of 7.5 “g/ml (6.2-X.2) (1C 95%), C-PSA of 5.7 ng/ml (4.4-6.6) and an average prostatic volume of 61.5 gr (54.71). The FIT ratio was significantly correlated with the degree of activity of inflammation, while no correlations were found between the levels of T-PSA, CPSA and C/T with the histological patterns of prostatitis of any degree. In particular, lower levels of F/T PSA were found where the invasion of the glandular epithelium meant a more advanced inflammation. A significant correlation was found between T-PSA (r=O.39), C-PSA (r=O.38) and L/T(r=0.35 ) with total prostate weight (p
2 (2003) NO. 1, pp. 50
MR-CYSTOURETHROGRAPHY: A NEW DIAGNOSTIC TECHNIQUE FOR THE EVALUATION OF MALE LOWER TRACT
Italy
MATERIAL & METHODS: Since February 2000. I79 patients with suspected BPH were enrolled in a prospective clinical trial and underwent TRUS to estimate prostatic volume by means of a 6.5 MHr end-fire probe (Hitachi MedIcal System) and EUB-525 machine. Twelve prostatic TRUS biopsies were performed prior to evaluation of serum T-PSA, F-PSA (Abbott Corp.) and C-PSA (Bayer Corp.) levels. The 105 patients with negative biopsies for prostatic adenocarcinoma underwent a special histological ebaluatlon to asbess the degree of inflammatton in terms of extension (grade 1: ~14 cores: grade II: 5-X cores; gnlde III: 9-12 corea) and activity ton a progressively increasing bcale of i points, according to the percentage ofintlammatory infiltrate subverting the glandular epithelium).
Urology
VOIDING IMAGING 1’RINARY
trc\chi
INTRODUCTION & OBJECTIVES: To verify whether the variability of complexed (C-PSA), free PSA (F-PSA), total ( r-PSA), the free/total (F/T) ratm and complexeditotal (C/T) ratio can bc correlated with the total volume of the prostate gland and/or with the degree of hystologically determined inflammation after prostatic biopsies in patients with benign prostatic hyperplasia (BPH).
European
correlation
114TERIAL & METHODS: 5 normal LOIU~~CCI-S and 12 mate patients with bladder outlet obstruction (evaluated with urine-flow velocity recordmg) underwent voiding MR-cystourethrography. The MR examination was performed with a I.5 Tcsla superconductive magnel (Philips NT 1.5, Philips Medical System) with the palient placed m supine position. The filling of the urinary bladder with paramagnetlc contrast agent was obtained by the i.v admmistratlon 20 mg of furosemide followed by the i.v. admlmstration of i 4 of the normal dose of a pammagnetic contrasl agent (Magncvlbt, Schering. Germany). When the bladder was tilled ot contrast-material-enhanced urine, the patient was asked to urinate. An appropriate urisheath wab placed at the tip of the penis m order to collect u-me urine and the patient had to advise when m,ctlon started. l)uring the micturition Tl-weIghted spoiled 3D gradient-echo acquisitions on sugittal plane were performed ( IR: 12 ms. TE. 2.7 ms: thp-angle: 40”: shce thlckners: 2 mm; ‘rcq time: I2 ‘) IWO consccutlve MR acqui\llions were pcrfol-mod and the 1l) j-o\\ images were post-processed with MIP algorithm. 25 patients performed Iretrograde and micturating conventional cystourethrography m the month preceding MRI. RESULTS: Homogeneous opacification of the bladder lumen was always obtained. 5 patients were unable to perform the MR examination. In all the volunteers and in all the patients studied (37 pts) we obtained a perfect evaluation of the male urethra with voiding MR.cystourethrography. The v1sualizatu.m ofthc urethra with MIP reconstructed images was considered comparable to that obtalned with conventional cystourethrography. We detected I2 cases of bladder neck obstruction, IX cases of urethral stricture (15single stricture; 3 double stricture), 5 casts follou’mg TURP and TlJlP procedures and 2 cases of benign prostatic hypertrophy. The site, length and the number of urethral strictures were accurately determined by MRI. The analysis of 3D bagittal scans allowed a better evaluation of the morphology of the urethral strictures in comparison with conventional cystourethrography. CONCLUSIONS: Voldmg MK-cystourethrography demonall-atcs the morfology of the bladder neck and urethra during the nncturition and can substitute standard retrograde and mlcturnting cystourethrogram This novel technique avoids radiation exposure to the ponads.
ANALOGUE SCALE TO EVALUATE THE SEVERITY OF BENIGN PROSTATIC HYPERPLASIA - A PILOT STUDY IN TWO UROLOGICAL CENTRES
reillac P.‘. Terrier N.‘, Rozct F.‘. Monglat-hrtus Kambcaud J.’
P.‘. Montauban V.I. Musrynski
R ‘.
190 AND TOTAL PROSTATE IN A POPULATION-BASED EARLY DETECTION
PROSTATE
VOLUME
Seberi G.‘. Horningcr G.‘. Bovle P.’
W.
, Bergor
A.
. Obrraigncr
SPECIFIC ANTIGEN PROGRAMME
W.‘, Robertson
C.‘. Bartach
‘HKpital Saint-Louis. Urology. Paris. brance. ‘Hdpital Albert Michalon, Chirurgie Urologique. Grenoble, France. ‘Yamanouchi Pharma France. Medical Affairs, Parir. France
‘European institute of Oncology. Milan. Italy, ‘University of Innsbruck, Urology, Innsbruck, t\ustria, ‘University of Innsbruck, Tyrol Cancer Registry. Innsbruck, -\ustria
INTRODUCTION & OBJECTIVES: Half of men older than SO years who have benign prostatic hyperplasia (BPH) arc not diagnosed. In addition. there are difficulties in using the International Prostate Symptom Score (I-P%) questionnaire m general practice. The aim of this pilot study was to investigate the correlation between the I-PSS questionnaire and a visual analogue scale (VAS) proposed as a ne\+ evaluation tool in BPH
INTRODUCTION & OBJECTIVES: Roehrbom ct al. (Urology 53:581SX9.1999) have demonstrated a positive correlation bctwccn total PSA and prostate volume in patients with clinical BPH. This association was mvrstigatcd among participants in a population-based early prostate cancer detection
MATERIAL & METHODS: 65 patlents (66*9 years, I-PSS: 13.6i7.0)
programme. Given the high participation rate. this is a more represenlativc sample of men from a general population. In addition, we examined associations with other factors including biopsy outcome, free PSA and transilion xmc 1 olume.
RESULTS: The values of the VAS wcrc independent of the age of the patient. The
MATERIAL & METHODS: A total of3.797 screening \oIuntccrs in the Tqrol PSA Screening Project. who underwent prostate biopsies were evaluated. Linear models were applied to srudy the association ofvarlous factors to (the logarithm of) prostate volume
from two urological centres in France were asked the question “how much of a problem do you have urinating?” They answered using a VAS of various lengths: scvcr~ patients noted a score on the VAS of IO and 35 cm Icngth. 30 patients rcphed on the I5 cm V.4S and 28 replied on the 20 cm VAS. In addition, they all completed the I-PSS.
four grades of seventy of the I-PSS were also represented for the VAS group\ (p-0.999). The 20 cm VAS showed the strongest correlation with the I-PSS (R=O.91. ~:O.OOOl). The correlation coefficients wcrc 0.26. 0.67 and 0.72 for the VAS of IO. 15and 35 cm. respectively. The figure below shows the relationship between the 20 cm VAS and the grades of scverltyin the I-PSS.
_ :*
T
T _
I
’ -
RESULTS: Median age. prostate volume and transition Lone volume are 64. 34cc and I3 cc respectively. A linear and positive correlation was found between prostate volume with total serum PSA and age; furthermore we found that the association between PSA and prostate volume increases signif,cantly with age (p iO.001). Also free PSA was positively associated with prostate volume (p iO.001). The increase in prostate volume with increasing age was not intluenced by biopsy findings. For transition Lone volume a positive association for age, total PSA and fret PSA was found. CONCLUSIONS:
CONCLLISIONS: This pdot study hhowcd a correlauon bctv,ccn the I-PSS results and the 20 cm VAS. This VAS could therefore bc used as a simple tool in the accuraIc assessment of BPH by general practitioners. A large-scale study IS necessary to calldate Its USCby general practitioners
As shobn previously in BPH patients. there is a positive between prostate volume and total serum PSA m the general male population. I’he association hctween total PSA and proatatc volume increases with age in a statistically sigmticant manner. Biopsy outcome (canccr/NbD) did not intluence the lncrcase 111prostate volume with increasing age.
191
192
IPEE
CORRELATIONS BETWEEN COMPLEXED, FREE AND TOTAL PSA LEVELS WITH PROSTATIC VOLUME AND HISTOLOGIC INFLAMMATION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA Scattoni V.‘. Montorsi F.‘. Rabcr M.‘. Naapro R. :M.‘, Potenloni M.‘. Rigatti P.’ ‘II San Raffaele, Urology.
Milan.
Paal A
Salonla A
Italy, ‘H San Raffaele. Pathology. Milan,
.
RESULTS: IO5 patients presented media&-PSA of 7.5 “g/ml (6.2-X.2) (1C 95%), C-PSA of 5.7 ng/ml (4.4-6.6) and an average prostatic volume of 61.5 gr (54.71). The FIT ratio was significantly correlated with the degree of activity of inflammation, while no correlations were found between the levels of T-PSA, CPSA and C/T with the histological patterns of prostatitis of any degree. In particular, lower levels of F/T PSA were found where the invasion of the glandular epithelium meant a more advanced inflammation. A significant correlation was found between T-PSA (r=O.39), C-PSA (r=O.38) and L/T(r=0.35 ) with total prostate weight (p
2 (2003) NO. 1, pp. 50
MR-CYSTOURETHROGRAPHY: A NEW DIAGNOSTIC TECHNIQUE FOR THE EVALUATION OF MALE LOWER TRACT
Italy
MATERIAL & METHODS: Since February 2000. I79 patients with suspected BPH were enrolled in a prospective clinical trial and underwent TRUS to estimate prostatic volume by means of a 6.5 MHr end-fire probe (Hitachi MedIcal System) and EUB-525 machine. Twelve prostatic TRUS biopsies were performed prior to evaluation of serum T-PSA, F-PSA (Abbott Corp.) and C-PSA (Bayer Corp.) levels. The 105 patients with negative biopsies for prostatic adenocarcinoma underwent a special histological ebaluatlon to asbess the degree of inflammatton in terms of extension (grade 1: ~14 cores: grade II: 5-X cores; gnlde III: 9-12 corea) and activity ton a progressively increasing bcale of i points, according to the percentage ofintlammatory infiltrate subverting the glandular epithelium).
Urology
VOIDING IMAGING 1’RINARY
trc\chi
INTRODUCTION & OBJECTIVES: To verify whether the variability of complexed (C-PSA), free PSA (F-PSA), total ( r-PSA), the free/total (F/T) ratm and complexeditotal (C/T) ratio can bc correlated with the total volume of the prostate gland and/or with the degree of hystologically determined inflammation after prostatic biopsies in patients with benign prostatic hyperplasia (BPH).
European
correlation
114TERIAL & METHODS: 5 normal LOIU~~CCI-S and 12 mate patients with bladder outlet obstruction (evaluated with urine-flow velocity recordmg) underwent voiding MR-cystourethrography. The MR examination was performed with a I.5 Tcsla superconductive magnel (Philips NT 1.5, Philips Medical System) with the palient placed m supine position. The filling of the urinary bladder with paramagnetlc contrast agent was obtained by the i.v admmistratlon 20 mg of furosemide followed by the i.v. admlmstration of i 4 of the normal dose of a pammagnetic contrasl agent (Magncvlbt, Schering. Germany). When the bladder was tilled ot contrast-material-enhanced urine, the patient was asked to urinate. An appropriate urisheath wab placed at the tip of the penis m order to collect u-me urine and the patient had to advise when m,ctlon started. l)uring the micturition Tl-weIghted spoiled 3D gradient-echo acquisitions on sugittal plane were performed ( IR: 12 ms. TE. 2.7 ms: thp-angle: 40”: shce thlckners: 2 mm; ‘rcq time: I2 ‘) IWO consccutlve MR acqui\llions were pcrfol-mod and the 1l) j-o\\ images were post-processed with MIP algorithm. 25 patients performed Iretrograde and micturating conventional cystourethrography m the month preceding MRI. RESULTS: Homogeneous opacification of the bladder lumen was always obtained. 5 patients were unable to perform the MR examination. In all the volunteers and in all the patients studied (37 pts) we obtained a perfect evaluation of the male urethra with voiding MR.cystourethrography. The v1sualizatu.m ofthc urethra with MIP reconstructed images was considered comparable to that obtalned with conventional cystourethrography. We detected I2 cases of bladder neck obstruction, IX cases of urethral stricture (15single stricture; 3 double stricture), 5 casts follou’mg TURP and TlJlP procedures and 2 cases of benign prostatic hypertrophy. The site, length and the number of urethral strictures were accurately determined by MRI. The analysis of 3D bagittal scans allowed a better evaluation of the morphology of the urethral strictures in comparison with conventional cystourethrography. CONCLUSIONS: Voldmg MK-cystourethrography demonall-atcs the morfology of the bladder neck and urethra during the nncturition and can substitute standard retrograde and mlcturnting cystourethrogram This novel technique avoids radiation exposure to the ponads.